Cashless

Cashless health insurance is a facility where the insurance company directly settles the hospital bills with the Network hospital, so the policyholder does not have to pay upfront (except for non-covered items or co-payments).

How to Avail Cashless Hospitalization

Step-by-Step Guide:

1. Visit a Network Hospital

   • Walk into any hospital listed under your insurer’s Network Hospital List.

   • (This list will be shared separately or is available on your insurer/TPA portal)

2. Inform the Right People

   • Immediately inform your HR SPOC about the hospitalization.

3. Carry These Documents

   • Your Mediclaim / Health Insurance Card

   • Photo ID proof (for both the employee and patient, if different)

4. Inform the Hospital

   • At reception or TPA/insurance helpdesk, inform that you are covered under a medical insurance policy.

5. Ask for Pre-Authorization Form

   • Request a Pre-Authorization Claim Form.

   • Get it filled by your treating doctor with necessary medical reports.

   • Many hospitals manage this for you — check with them.

6. Submit the Form

   • The filled form and reports are sent to your TPA/insurer — typically done by the hospital.

   • If not, you can scan and mail them yourself.

7. Claim Processing

   • The insurer/TPA will review your claim and respond within 4 to 6 hours (often quicker).

   • You may be asked for more information or, in rare cases, face a temporary denial (only if the treatment is not covered under your policy).

   • If any issues arise, PlanCover can help in challenging or re-validating the decision.

8. Possible Reasons for Rejection or Partial Approval

   • Ailment not covered under the policy

   • Sum insured exhausted

   • Non-medical items not covered (e.g., toiletries, food)

   • Policy features like co-pay or deductible

   • Treatment capping limits

9. Discharge & Final Billing

   • Even if your doctor advises discharge early, billing can take a few hours.

   • Hospital generates final bill + discharge summary.

   • Sent to insurer for final approval.

10. Final Authorization

• After evaluation, the insurer sends Final Authorization to the hospital.

• Hospital billing desk will let you know if there’s any balance to be paid.

• If you feel a deduction is unfair, reach out — we can take it up with the insurer.

11. Advance Deposits (If Any)

• Some hospitals may ask for an initial deposit — this varies.

• Any excess you paid (beyond policy limits or co-pay), will be refunded after insurer settlement.